Ecstasy may help brain cope with trauma

Sunday

Nov 25, 2012 at 6:00 AM

By Benedict Carey THE NEW YORK TIMES

Hundreds of Iraq and Afghanistan veterans with post-traumatic stress have recently contacted a husband-and-wife team who work out of their home in suburban South Carolina to seek help. Many are desperate, pleading for treatment and willing to travel to get it.

The soldiers have no interest in traditional talking cures or prescription drugs that have given them little relief. They are lining up to try an alternative: MDMA, better known as Ecstasy, a party drug that surfaced in the 1980s and '90s that can induce pulses of euphoria and a radiating affection.

Government regulators criminalized the drug in 1985, placing it on a list of prohibited substances that includes heroin and LSD. But in recent years, regulators have licensed a small number of labs to produce MDMA for research purposes.

“I feel survivor's guilt, both for coming back from Iraq alive and now for having had a chance to do this therapy,” said Anthony, a 25-year-old living near Charleston, S.C., who asked that his last name not be used because of the stigma of taking the drug. “I'm a different person because of it.”

In a paper posted online Tuesday by the Journal of Psychopharmacology, Michael and Ann Mithoefer, the husband-and-wife team offering the treatment — which combines psychotherapy with a dose of MDMA — write that they found 15 of 21 people who recovered from severe post-traumatic stress in the therapy in the early 2000s reported minor to virtually no symptoms today. Many said they have received other kinds of therapy since then, but not with MDMA.

The Mithoefers — he is a psychiatrist and she is a nurse — collaborated on the study with researchers at the Medical University of South Carolina and the nonprofit Multidisciplinary Association for Psychedelic Studies.

The patients in this group included mostly rape victims, and experts familiar with the work cautioned that it was preliminary, based on small numbers, and its applicability to war trauma entirely unknown. A spokeswoman for the Defense Department said the military was not involved in any research of MDMA.

But given the scarcity of good treatments for post-traumatic stress, “there is a tremendous need to study novel medications,” including MDMA, said Dr. John H. Krystal, chairman of psychiatry at the Yale School of Medicine.

The study is the first long-term test to suggest that psychiatrists' tentative interest in hallucinogens and other recreational drugs — which have been taboo since the 1960s — could pay off. And news that the Mithoefers are beginning to test the drug in veterans is out, in the military press and on veterans' blogs. “We've had more than 250 vets call us,” Mithoefer said. “There's a long waiting list, we wish we could enroll them all.”The couple, working with other researchers, will treat no more than 24 veterans with the therapy, following Food and Drug Administration protocols for testing an experimental drug; MDMA is not approved for any medical uses.

A handful of similar experiments using MDMA, LSD or marijuana are in the works in Switzerland, Israel and Britain, as well as in this country. Both military and civilian researchers are watching closely. So far, the research has been largely supported by nonprofit groups.“When it comes to the health and well-being of those who serve, we should leave our politics at the door and not be afraid to follow the data,” said Brig. Gen. Loree Sutton, a psychiatrist who recently retired from the Army. “There's now an evidence base for this MDMA therapy and a plausible story about what may be going on in the brain to account for the effects.”

In interviews, two people who have had the therapy — one, Anthony, currently in the veterans study, and another who received the therapy independently — said that MDMA produced a mental sweet spot that allowed them to feel and talk about their trauma without being overwhelmed by it.

“It changed my perspective on the entire experience of working at ground zero,” said Patrick, a 46-year-old living in San Francisco, who worked long hours in the rubble after the Sept. 11, 2001, attacks searching in vain for survivors, as desperate family members of the victims looked on, pleading for information. “At times I had this beautiful, peaceful feeling down in the pit, that I had a purpose, that I was doing what I needed to be doing. And I began in therapy to identify with that,” rather than the guilt and sadness.

The Mithoefers administer the MDMA in two doses over one long therapy session, which comes after a series of weekly nondrug sessions to prepare. Three to five weeks later, they perform another drug-assisted session; and again, patients engage in 90-minute nondrug therapy before and after, once each week.

Most have found that their score on a standard measure of symptoms — general anxiety, hyperarousal, depression, nightmares — drops about 75 percent. That is more than twice the relief experienced by people who get psychotherapy without MDMA, the Mithoefers said.

The couple work as a team, sitting with the patient for as long as the altered state lasts.

“It's very much a nondirected therapy,” Mithoefer said. “We're with them for 8-10 hours, usually, and we alternate between having them talk to us and having them focus on the trauma. Part of what we're trying to do is help the person stay with the memory even if it's difficult.”

For many people, the experience in treatment is emotionally vivid, Mithoefer continued. The drug does not produce a “high,” but it usually brings some tranquility.

Studies of people taking MDMA suggest that the drug induces, among other things, the release of a hormone called oxytocin, which is thought to increase sensations of trust and affection. The drug also seems to tamp down activity in a brain region called the amygdala, which flares during fearful, threatening situations.

“The feeling I got was nothing at all for 45 minutes, then really bad anxiety, and I was fighting it at first,” said Anthony, the Iraq veteran, who patrolled southwest of Baghdad in 2006 and 2007 amid relentless insurgent harassment and attacks with improvised explosive devices. “And then — I don't know how to put it, exactly — I felt OK and messed up at the same time. Clear. It was almost like I could go into any thought I wanted and fix it.”

For instance, he could think and talk about an attack that occurred in a town near Baghdad, in which Iraqis posing as allies — and who had been armed by the U.S. military — turned their guns on U.S. troops, killing several. The unit could not quickly evacuate its wounded because of weather conditions. Anthony's rage and grief were so overwhelming that he had to suppress them and did so for years.

“The military does a great job of turning you into a soldier, of teaching you how to control your reactions, and it is hard to turn those habits off,” Anthony said.

He said he no longer struggled with post-traumatic anxiety or guilt, more than a year after undergoing the MDMA-assisted treatment. In the new report, the Mithoefers write that they found 80 percent of the patients treated in the early 2000s reported that much or all of the initial benefit they achieved on this standard test persisted a year to five years after the therapy ended.

If the results among veterans are anywhere near as powerful and lasting, researchers said, it is likely that the government would be willing to pay for a larger trial.

“That is really what we're aiming for, and we're doing it carefully,” said Rick Doblin, the executive director of the Multidisciplinary Association for Psychedelic Studies, which financed the MDMA study. “After all this cultural turmoil, the split between the military and the psychedelic community, it would really be something if we could come together and use some of these drugs to help people.”